SPECT/CT融合显像对乳腺癌骨转移的诊断价值

目的 评价SPECT/CT融合显像对^99Tc^m-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值.方法 对^99Tc^m-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异.结果 ①210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个（39.0％）,良性病灶112个（53.3％）,诊断准确率为92.4％（194/210）,灵敏度为94.3％,特异度为91.1％,阳性预测值为88.2％,阴性预测值为95.7％.②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9％（94/97）,肋骨最低,为83.7％（36/43）,其差异有统计学意义（χ^2=7.81,P＜0.05）.结论 SPECT/CT同机融合显像能够对^99Tc^m-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低.

Clinical value of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in breast cancer

Objective To evaluate the diagnostic value of SPECT/CT fusion imaging in indeter-minate lesions on ^99Tc^m-MDP whole-body bone scan in patients with breast cancer.Methods 210 bone lesions of 132 patients with breast cancer,for whom the natures of the lesions were unable to be determined by the ^99Tc^m-MDP whole-body bone scan,were examined by the SPECT/CT fusion imaging simultaneously.The natures of the lesions were eventually confirmed by pathology and clinical follow-up.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of SPECT/CT fusion imaging for diagnosing bone-metastases were calculated.In addition,the diagnostic accuracy of SPECT/CT fusion imaging for bone lesions in various parts of the body was also analyzed.Results ①Of 210 bone lesions,82 of bone metastases and 112 benign bone lesions were correctly diagnosed by SPECT/CT fusion imaging.The diagnostic accuracy,sensitivity,specificity,positive prediction value and negative prediction value was 92.4% （194/210）,94.3% （82/87）,91.1% （112/123）,88.2% （82/93）,95.7% （112/117）,respectively.②The diagnostic accuracy of ^99Tc^m-MDP SPECT/CT for spinal bone lesions were significantly higher than that for rib lesions （95.9% versus 83.7%,χ^2=7.81,P〈0.05）.Conclusions ①92.4% bone lesions in patients with breast cancer,which can not determined on 99Tcm-MDP whole-body bone scan,can be diagnosed by SPECT/CT fusion imaging accurately.②Diagnositic compliance rate of SPECT/CT fusion imaging is different in different parts with obscure lesion,which is the highest in the spine,the minimum in ribs.